Healthcare Provider Details

I. General information

NPI: 1558372508
Provider Name (Legal Business Name): LAILA NIAZI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOWE AVENUE SUITE 100
SACRAMENTO CA
95825
US

IV. Provider business mailing address

650 HOWE AVENUE SUITE 100
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-9337
  • Fax: 916-924-8281
Mailing address:
  • Phone: 916-924-9337
  • Fax: 916-924-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91451
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA914510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: